"Qualitative vs. Quantitative": When Medicare Thinks you are Dead

“Torture Data Long Enough, it will confess to anything. . .”

-- Economist, Ronald Chase.?

I was reminded this week, of the difference in qualitative and quantitative data, when I received in the mail, a certificate admitting me to the Texas Bar College, “Society of Legal Scholars.” ?Apparently, I have 77 hours of MCLE credit this year.

?Honestly, all I did was move across the street from the Dallas Bar Association headquarters at the Belo Mansion, where they have a very good lunch buffet. A buffet which comes with a free 1.00 hour CLE presented by any of about 30 different practice sections. Could be Tax Law one day, and Intellectual Property the next.?

I wasn’t trying to be a great "legal scholar," was just hungry, and walked across the street for lunch and needed a place to sit-- on 77 different occasions. On most of which, I will freely admit, I had no idea what the speaker was talking about. (I don’t know whether to frame the certificate or send it back.)

?Reminds of when I was in law school at Ole Miss. We had a punter who made the cover of Sports Illustrated as an All American. He had the longest punting average in the country, even though he didn’t kick the ball any farther than anybody else.?And everybody knew it. How is this possible? ?

?There was a second punter, you see, who was the coach’s son. He was terrible when it came to kicking the ball very far, but could kick accurately. So, the coach put is son in for short punts, and put the All American in the game to boom away, but only for the long punts. The All American made the cover of Sports Illustrated, only because nobody ever asked him to kick a shorter punt. A case of "quantitative" data over "qualitative."

?What happens when Medicare thinks you are "Dead." If you have a fundamental need for qualitative data to make any sense, at all, then you probably wouldn’t make for a good Medicare regulator. I just won a CMS Medicare case on appeal, last Friday, reversing a Medicare participation revocation for a Sleep Center, declaring it "dead", when it was only trying to change its address, because it had moved across town.

?In order to enroll in the Medicare program, the first condition of participation is that you must exist. Sounds fair, a rule which was probably adopted with the best of intentions, what could possibly go wrong?

?Turns out, "plenty."?My client moved its operations, notified Medicare through the PECOS system, which is the electronic portal, through which all things Medicare are transacted. This triggered a site inspection, in which a Medicare inspector actually showed up at my client’s existing offices and conducted the site inspection.

?Unfortunately, someone with the Sleep Center accidentally entered the wrong date in the PECOS system, mixing up the closing date of operations at the old address, with the date they actually started operations, which was 2012. Thus, inadvertently, telling the Medicare PECOS system, that my client had ceased to exist in 2012.

?Easy problem, easy fix, right? Just go back into the PECOS system, and change the date to the correct date. After all, there was "qualitative data," the CMS inspector was?literally standing in the client’s functioning sleep center, which was clearly "not dead," conducting a site inspection.

?Not so fast. Turns out, once a participant accidentally tells the CMS PECOS system that it no longer exists, then it gets locked out and cannot correct the error. I had the CMS Deputy Director, Division of Provider Enrollment Appeals on speed dial, guessing at what my client should do, when the government thinks he is "dead."

It took 7 months of CMS appeals to get the client back into good graces with CMS. This, even though the inspector was actually standing in my client’s existing practice, at the time the Medicare bureaucracy had declared my client "dead," and therefore, could not "possibly exist."

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"Merry Christmas," to all clients and friends. Have a safe holidays